Provider Demographics
NPI:1841456258
Name:GONZALEZ, ANA JACKSON (MS, RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:JACKSON
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-2538
Mailing Address - Country:US
Mailing Address - Phone:956-487-8458
Mailing Address - Fax:956-487-8458
Practice Address - Street 1:1508 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-2538
Practice Address - Country:US
Practice Address - Phone:956-487-8458
Practice Address - Fax:956-487-8458
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered